John Bicket - 14 Dec 2021 Form 3 Insider Report for Samsara Inc. (IOT)

Role
Executive Vice President, Chief Technology Officer Power of Attorney, Director, 10%+ Owner
Signature
/s/ Adam Eltoukhy, attorney-in-fact on behalf of John Bicket
Issuer symbol
IOT
Transactions as of
14 Dec 2021
Net transactions value
$0
Form type
3
Filing time
14 Dec 2021, 20:28:54 UTC
Next filing
21 Dec 2021
SEC
View on sec.gov

Derivative Securities (e.g., puts, calls, warrants, options, convertible securities)

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Underlying Class Amount Exercise Price Ownership Footnotes
holding IOT Class B Common Stock 14 Dec 2021 Class A Common Stock 1,286,597 Direct F1
holding IOT Stock Option (right to buy) 14 Dec 2021 Class B Common Stock 570,031 $3.51 Direct F2
holding IOT Class B Common Stock 14 Dec 2021 Class A Common Stock 66,533,236 See footnote F1, F4
holding IOT Series A Preferred Stock 14 Dec 2021 Class B Common Stock 12,386,955 See footnote F3, F4
holding IOT Series B Preferred Stock 14 Dec 2021 Class B Common Stock 4,629,639 See footnote F3, F4
holding IOT Series C Preferred Stock 14 Dec 2021 Class B Common Stock 1,351,441 See footnote F3, F4
holding IOT Class B Common Stock 14 Dec 2021 Class A Common Stock 2,292,432 See footnote F1, F5
holding IOT Class B Common Stock 14 Dec 2021 Class A Common Stock 15,591,942 See footnote F1, F6
holding IOT Class B Common Stock 14 Dec 2021 Class A Common Stock 2,292,432 See footnote F1, F7
holding IOT Class B Common Stock 14 Dec 2021 Class A Common Stock 1,286,597 See footnote F1, F8
holding IOT Class B Common Stock 14 Dec 2021 Class A Common Stock 4,466,764 See footnote F1, F9
holding IOT Class B Common Stock 14 Dec 2021 Class A Common Stock 250,000 See footnote F1, F10
holding IOT Class B Common Stock 14 Dec 2021 Class A Common Stock 250,000 See footnote F1, F11
holding IOT Class B Common Stock 14 Dec 2021 Class A Common Stock 250,000 See footnote F1, F12
* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Explanation of Responses:

Id Content
F1 The Class B Common Stock is convertible at any time, at the holder's election, into Class A Common Stock on a 1:1 basis and has no expiration date.
F2 1/48 of the total shares subject to the Option vested on March 4, 2019 and thereafter 1/48 of the shares subject to the Option vest each month thereafter on the same day of the month.
F3 The Series A, Series B and Series C Preferred Stock are each convertible into Class B Common Stock on a 1:1 basis and have no expiration date. Upon the closing of the Issuer's initial public offering, all shares of Series A, Series B and Series C Preferred Stock will be converted into shares of Class B Common Stock of the Issuer. The Class B Common Stock is convertible at any time, at the holder's election, into Class A Common Stock on a 1:1 basis.
F4 Consists of shares held by John C. Bicket, Trustee of the John C. Bicket Revocable Trust u/a/d 2/15/2013, over which Mr. Bicket has voting or investment power.
F5 Consists of shares held by CBD, Trustee of The CBD 2020 Annuity Trust u/a/d 12/23/2020, over which Mr. Bicket has voting or investment power.
F6 Consists of shares held by Jordan Park Trust Company, LLC, Trustee of The Bicket-Dobson Trust II u/a/d 10/8/2021, over which Mr. Bicket has voting or investment power.
F7 Consists of shares held by John C. Bicket, Trustee of The John C. Bicket 2020 Annuity Trust u/a/d 12/23/2020, over which Mr. Bicket has voting or investment power.
F8 Consists of shares held by Mr. Bicket's spouse.
F9 Consists of shares held by Jordan Park Trust Company, LLC, Trustee of The Bicket-Dobson Trust I u/a/d 11/10//2021, over which Mr. Bicket has voting or investment power.
F10 Consists of shares held by Jordan Park Trust Company, LLC, Trustee of The Bicket-Dobson Trust I-A fbo ACDB u/a/d 11/10/2021, over which Mr. Bicket has voting or investment power.
F11 Consists of shares held by Jordan Park Trust Company, LLC, Trustee of The Bicket-Dobson Trust I-A fbo JCDB u/a/d 11/10/2021, over which Mr. Bicket has voting or investment power.
F12 Consists of shares held by Jordan Park Trust Company, LLC, Trustee of The Bicket-Dobson Trust I-A u/a/d 11/10/2021, over which Mr. Bicket has voting or investment power.

Remarks:

Executive Vice President, Chief Technology Officer Power of Attorney